Healthcare Provider Details

I. General information

NPI: 1003792037
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13285 MINNIEVILLE RD STE 103
WOODBRIDGE VA
22192-4018
US

IV. Provider business mailing address

4000 GARDEN CITY DR
HYATTSVILLE MD
20785-2418
US

V. Phone/Fax

Practice location:
  • Phone: 703-986-2400
  • Fax:
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN SWINTON
Title or Position: DIRECTOR, CREDENTIALING
Credential:
Phone: 301-257-2797